Cancer Causes & Control

, Volume 26, Issue 7, pp 1019–1026 | Cite as

Survival among Black and White patients with renal cell carcinoma in an equal-access health care system

  • Jie LinEmail author
  • Shelia H. Zahm
  • Craig D. Shriver
  • Mark Purdue
  • Katherine A. McGlynn
  • Kangmin ZhuEmail author
Original paper



Unequal access to health care may be a reason for shorter survival among Black patients with renal cell carcinoma (RCC) than among their White counterparts. No studies have investigated survival disparity among RCC patients in an equal-access health care delivery system. This study aimed to examine racial differences in survival among clear cell RCC patients in the Department of Defense’s (DoD) Military Health System (MHS), which provides equal access to care to all persons.


The study used the DoD’s Automated Central Tumor Registry to identify 2056 White patients and 370 Black patients diagnosed with clear cell RCC between 1988 and 2004. The subjects were followed through 2007 with a median follow-up time of 4.8 years. Kaplan–Meier survival curves were compared and a Cox model was used to estimate the hazard ratios (HRs) associated with survival by race.


During follow-up, 1,027 White and 158 Black patients died. The Kaplan–Meier curves showed that Black patients had more favorable overall survival than did White patients (log rank p = 0.031). After adjustment for demographic, tumor, and treatment variables, the Cox model showed no statistically significant racial difference overall (adjusted HR 1.07, 95 % CI 0.90–1.28) or stratified by age, sex or tumor stage. However, among patients who did not undergo surgery, Black patients had poorer survival than White patients.


The lack of racial difference in survival among RCC patients in the MHS may be related to equal access to health care. Improved access could reduce the survival disparity among RCC patients in the general population.


Renal cell carcinoma Racial disparity Survival Equal access Hazard ratio 



This project was supported by John P. Murtha Cancer Center, Walter Reed National Military Medical Center via the Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine, and by the intramural research program of the National Cancer Institute. The authors thank the Joint Pathology Center (formerly Armed Forces Institute of Pathology) for providing the data. We thank Mr. Derek Brown for his input in statistical analysis.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30PubMedCrossRefGoogle Scholar
  2. 2.
    Chow WH, Dong LM, Devesa SS (2010) Epidemiology and risk factors for kidney cancer. Nat Rev Urol 7:245–257PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Janzen NK, Perry KT, Schulam PG (2003) Laparoscopic radical nephrectomy and minimally invasive surgery for kidney cancer. Cancer Treat Res 116:99–117PubMedGoogle Scholar
  4. 4.
    Lam JS, Klatte T, Kim HL, Patard JJ, Breda A et al (2008) Prognostic factors and selection for clinical studies of patients with kidney cancer. Crit Rev Oncol Hematol 65:235–262PubMedCrossRefGoogle Scholar
  5. 5.
    Chow WH, Shuch B, Linehan WM, Devesa SS (2013) Racial disparity in renal cell carcinoma patient survival according to demographic and clinical characteristics. Cancer 119:388–394PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Stafford HS, Saltzstein SL, Shimasaki S, Sanders C, Downs TM et al (2008) Racial/ethnic and gender disparities in renal cell carcinoma incidence and survival. J Urol 179:1704–1708PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Berndt SI, Carter HB, Schoenberg MP, Newschaffer CJ (2007) Disparities in treatment and outcome for renal cell cancer among older black and white patients. J Clin Oncol 25:3589–3595PubMedCrossRefGoogle Scholar
  8. 8.
    Vaishampayan UN, Do H, Hussain M, Schwartz K (2003) Racial disparity in incidence patterns and outcome of kidney cancer. Urology 62:1012–1017PubMedCrossRefGoogle Scholar
  9. 9.
    Eisenberg MS, Leibovich BC, Kim SP (2013) Racial disparity in renal cell carcinoma patient survival according to demographic and clinical characteristics. Cancer 119:3100PubMedCrossRefGoogle Scholar
  10. 10.
    Zini L, Perrotte P, Capitanio U, Jeldres C, Duclos A et al (2009) Race affects access to nephrectomy but not survival in renal cell carcinoma. BJU Int 103:889–893PubMedCrossRefGoogle Scholar
  11. 11.
    Tripathi RT, Heilbrun LK, Jain V, Vaishampayan UN (2006) Racial disparity in outcomes of a clinical trial population with metastatic renal cell carcinoma. Urology 68:296–301PubMedCrossRefGoogle Scholar
  12. 12.
    Shavers VL, Brown ML (2002) Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst 94:334–357PubMedCrossRefGoogle Scholar
  13. 13.
    Guidry JJ, Aday LA, Zhang D, Winn RJ (1997) Transportation as a barrier to cancer treatment. Cancer Pract 5:361–366PubMedGoogle Scholar
  14. 14.
    Guidry JJ, Aday LA, Zhang D, Winn RJ (1998) Cost considerations as potential barriers to cancer treatment. Cancer Pract 6:182–187PubMedCrossRefGoogle Scholar
  15. 15.
    Mulligan CR, Meram AD, Proctor CD, Wu H, Zhu K et al (2006) Unlimited access to care: effect on racial disparity and prognostic factors in lung cancer. Cancer Epidemiol Biomarkers Prev 15:25–31PubMedCrossRefGoogle Scholar
  16. 16.
    Zheng L, Enewold L, Zahm SH, Shriver CD, Zhou J et al (2012) Lung cancer survival among black and white patients in an equal access health system. Cancer Epidemiol Biomarkers Prev 21:1841–1847PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Akerley WL 3rd, Moritz TE, Ryan LS, Henderson WG, Zacharski LR (1993) Racial comparison of outcomes of male Department of Veterans Affairs patients with lung and colon cancer. Arch Intern Med 153:1681–1688PubMedCrossRefGoogle Scholar
  18. 18.
    Dominitz JA, Samsa GP, Landsman P, Provenzale D (1998) Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system. Cancer 82:2312–2320PubMedCrossRefGoogle Scholar
  19. 19.
    Andaya AA, Enewold L, Zahm SH, Shriver CD, Stojadinovic A et al (2013) Race and colon cancer survival in an equal-access health care system. Cancer Epidemiol Biomarkers Prev 22:1030–1036PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Bergan RC, Walls RG, Figg WD, Dawson NA, Headlee D et al (1997) Similar clinical outcomes in African-American and non-African-American males treated with suramin for metastatic prostate cancer. J Natl Med Assoc 89:622–628PubMedCentralPubMedGoogle Scholar
  21. 21.
    Patard JJ, Leray E, Rioux-Leclercq N, Cindolo L, Ficarra V et al (2005) Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol 23:2763–2771PubMedCrossRefGoogle Scholar
  22. 22.
    Capitanio U, Cloutier V, Zini L, Isbarn H, Jeldres C et al (2009) A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU Int 103:1496–1500PubMedCrossRefGoogle Scholar
  23. 23.
    Fritz APC, Lack A et al (2000) International classification of diseases for oncology, 3rd edn. World Health Organization, GenevaGoogle Scholar
  24. 24.
    Karami S, Young HA, Henson DE (2007) Earlier age at diagnosis: another dimension in cancer disparity? Cancer Detect Prev 31:29–34PubMedCrossRefGoogle Scholar
  25. 25.
    Eley JW, Hill HA, Chen VW, Austin DF, Wesley MN et al (1994) Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA 272:947–954PubMedCrossRefGoogle Scholar
  26. 26.
    Hegarty V, Burchett BM, Gold DT, Cohen HJ (2000) Racial differences in use of cancer prevention services among older Americans. J Am Geriatr Soc 48:735–740PubMedCrossRefGoogle Scholar
  27. 27.
    Optenberg SA, Thompson IM, Friedrichs P, Wojcik B, Stein CR et al (1995) Race, treatment, and long-term survival from prostate cancer in an equal-access medical care delivery system. JAMA 274:1599–1605PubMedCrossRefGoogle Scholar
  28. 28.
    Purnell TS, Xu P, Leca N, Hall YN (2013) Racial differences in determinants of live donor kidney transplantation in the United States. Am J Transpl 13:1557–1565CrossRefGoogle Scholar
  29. 29.
    Hofmann JN, Schwartz K, Chow WH, Ruterbusch JJ, Shuch BM et al (2013) The association between chronic renal failure and renal cell carcinoma may differ between black and white Americans. Cancer Causes Control 24:167–174PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr (1999) Rising incidence of renal cell cancer in the United States. JAMA 281:1628–1631PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Jie Lin
    • 1
    Email author
  • Shelia H. Zahm
    • 2
  • Craig D. Shriver
    • 1
    • 3
    • 4
  • Mark Purdue
    • 2
  • Katherine A. McGlynn
    • 2
  • Kangmin Zhu
    • 1
    • 4
    Email author
  1. 1.Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer CenterWalter Reed National Military Medical CenterRockvilleUSA
  2. 2.Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaUSA
  3. 3.General Surgery ServiceWalter Reed National Military Medical CenterBethesdaUSA
  4. 4.Uniformed Services UniversityBethesdaUSA

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